The publication of the Francis report has further increased the pressure on chief executives to bring about change. The question of how the NHS workforce can be encouraged and empowered to make required improvements is one all leaders must now urgently address. At Taunton and Somerset Foundation Trust the attempt to find the answer began some time ago.

‘Leadership does not start and end at the office doors of the executive team’

“Around the time David Nicholson announced the challenge, we started to look at how we were going to develop an organisation with the right cultural ingredients to enable its staff to change,” explains chief executive Jo Cubbon, who has been head of the trust since 2008.

“That level of efficiency was going to be about how we changed the way we worked within the NHS. I didn’t underestimate that. So it’s a journey we started three and a half years ago, and it’s built on a belief that an engaged workforce will drive the right change and better patient experience.”

That belief meant the journey began with an exercise with an outcome Ms Cubbon describes as “fairly brutal”. The trust contracted an external partner to measure levels of staff engagement − “I think we are the only NHS organisation that has ever done that” − and the results were not positive.

“The survey said we weren’t a very engaged organisation. People didn’t feel engaged, people didn’t feel skilled to take on some of those challenges; we didn’t communicate and work in such a way that they felt part of the solutions that they wanted to be part of.”

The big conversation

Changing that situation − creating engaged staff willing to embrace change − has involved several strands of work. One of the most important is based on the recognition that leadership does not start and end at the office doors of the executive team.

‘I would like staff to be in a place where they really are comfortable and confident embracing change’

“We put in a programme called Leadership Matters, so very much looking at how do we develop leadership skills throughout the organisation,” explains Ms Cubbon. “We have made significant investment in coaching and supporting our leaders, because leadership isn’t about anything that happens at the top − it is about something that happens throughout an organisation.”

Also important has been creating the time, space and opportunities for staff to share their frustrations and concerns. To that end, a listening and action programme has been introduced. One of its major components is “the big conversation”, an initiative which began last summer with Ms Cubbon running sessions for around 100 staff at a time. The sessions were a chance for staff to highlight areas ripe for improvement.

“We got some really practical things out of those sessions and then it was − and I think this is very much about leadership − how do you then get some quick wins? How do you start breaking down some of the boundaries of people feeling everything’s such a trudge, and that it takes weeks and months to sort things? Where are those decisions that need to be made by the leaders in an organisation just to get things done?”

Challenging times

Ms Cubbon does not pretend that the process of creatizg a change-ready trust is one that is complete. But she is confident the organisation is on the right track.

“If you provide the environment for people to have these conversations, to understand what is wrong with their area and what they want to change, they will improve the right things.

“It is hard, there are challenging times, but there’s still no better job than to be a leader in the NHS because we have the privilege of leading change that is actually going to make an impact on people’s lives,” she continues. “It’s our job to work our way through, so we’re leading organisations to make changes that ensure the continuing delivery of safe patient care in an environment where there is less money.”

Her answer to where she wants people in her organisation to be in a few years’ time is therefore unsurprising.

“I would like them to be in a place where they really are comfortable and confident embracing change,” she says simply, “at the forefront of challenging their own services to continually improve for the patient.”

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